Quick Question About Propranolol Reduction?

[mischamoonlight]

Hi, just wanted to ask quickly about beta blockers/ propranolol. I’ve been on Half-Beta Prograne 80mg slow release for 2 years, one a day. I spoke with my doctor last week about going on a lower dose to eventually come off. So she said I could stop or take one then skip a day. But I said I preferred to taper, so she prescribed me 40mg propranolol to take once a day. I took my last 80mg yesterday and am suppose to be starting my half dose 40mg today, and I’m just a little anxious about symptoms or withdrawals.

I’m 36yr old female, I have the occasional PVCs, but had loads of eggs and a 24hr heart monitor too and all of them were normal.

I suffer with severe anxiety and that’s why I was on the beta blockers. So just wanted to ask about side effects or if anyone has advice how to handle tapering.

[mischamoonlight]

Update: I just took my first 40mg propranolol. My last slow release beta blocker was yesterday so this is half my usual dose and not slow release, but I’m assuming that some of the slow release will still be in my system because I was on it for 2 years? I just don’t want any bad side effects or withdrawals, like palpitations or anything. I mean, my doctor was totally fine with me stopping my slow release 80mg completely or skipping a day or so, but agreed to do the lower dose for me, so see how it goes. Anyone done this with propranolol before? Tapered/weaned off to a lower dose and if so, did you notice any symptoms?

[nomorepanic]

Hi

This is just a courtesy reply to let you know that your post was moved from its original place to a sub-forum that is more relevant to your issue.

This is nothing personal - it just enables us to keep posts about the same problems in the relevant forums so other members with any experience with the issues can find them more easily.

Please also read this post:

http://www.nomorepanic.co.uk/showthread.php?t=213239

[mischamoonlight]

I think I’m just more worried because of the PVCs I’ve had the last year, and if that will effect me when being on a lower dose. I don’t want to get myself into a state of frenzied panic, but yeah it’s just playing on my mind, about palpitations and my PVCs etc.

[panic_down_under]

Hi, just wanted to ask quickly about beta blockers/ propranolol. I've been on Half-Beta Prograne 80mg slow release for 2 years, one a day. I spoke with my doctor last week about going on a lower dose to eventually come off.

If you come off how will your "severe anxiety" be treated?

So she said I could stop or take one then skip a day. But I said I preferred to taper, so she prescribed me 40mg propranolol to take once a day. I took my last 80mg yesterday and am suppose to be starting my half dose 40mg today, and I'm just a little anxious about symptoms or withdrawals.

Beta blockers don't have withdrawal issues in the way benzodiazepines and antidepressants do, but there can be some rebound effects on blood pressure and heart rates including PVCs which are usually minimized by tapering off. However, an anxious mind can manifest a range of unpleasant symptoms if allowed to ruminate on side/withdrawal effects.

I'm assuming that some of the slow release will still be in my system because I was on it for 2 years?

Not a lot. Propranolol has a half-life of about 5 hours so will usually be out of your system within 25 hours.

I just don't want any bad side effects or withdrawals, like palpitations or anything. I mean

As per above, an anxious mind is capable of creating our worst fears if given the chance. If you do experience palpitations, etc, they will more likely to be triggered by your mind.

Fwiw, palpitations and PVCs are normal and don't usually indicate anything harmful. Some chaos in the heart's rhythm is normal. In fact it seems to be required. The very worst sign is a heart beating in unvarying rhythm as it often heralds heart failure (and before everyone starts feeling their pulse, you need an EKG/ECG to detect this). A healthy heart dances, a failing one can only march.

[mischamoonlight]

@panic_down_under Hi! I’m not going to be coming off them completely, I wanted to work on a lower dose, as my doctor a while ago had told me about another anxiety medication. So eventually I’d want to come off the propranolol and try that instead. But I I’m not going to be coming off for a while, just while I try to get better myself. Trying to do more exercise and be healthier that way. But for now just get down to a smaller dose.

I think just from reading online, it’s always saying how you shouldn’t "stop as it’s dangerous, or it will cause heart issues" etc, so I think I just took that literally, but that might mean for patients who have heart conditions. As I’ve said, I’ve had numerous ECGs and a couple months back I had a 24 hour heart monitor which came back normal as well. Plus, I was only at the doctor earlier last week and she checked me there too, blood pressure as normal too, for once lol! It was purely for the anxiety symptoms.

I thought the slow release lasted longer in the body? Well, my last half-beta Prograne 80mg slow release was on Tuesday, and took my first 40mg yesterday. So far today, can’t notice a drastic change, so see how I go. I’m still having a few PVCs but so far not many. I know their normal, but they still feel really weird and can make you feel a little anxious when you can feel them sometimes. So I’m assuming the slow release is well out of my body now? Even if I was taking it everyday for 2 years, when you stop does it come out of your system after 25 hours?

My mind works overtime even when taking a new medication or going on a lower dose, everything really and I’ve been working really hard to try stop it from doing that but it’s an ongoing process to be honest. Thanks for replying, I always say it, but it’s really good talk to someone who’s more logical than me when I’m in this thought process. So I appreciate it.

[panic_down_under]

@panic_down_under Hi! I'm not going to be coming off them completely, I wanted to work on a lower dose, as my doctor a while ago had told me about another anxiety medication.

Beta blockers like propranolol aren't really anti-anxiety meds. All it do is reduce the adrenaline, aka epinephrine, fueled symptoms of anxiety. Unlike antidepressants (ADs) and therapy they don't address the underlying brain dysfunction which manifest anxiety and depression.

So eventually I'd want to come off the propranolol and try that instead.

You don't need to stop taking propranolol if you're switching to an AD and there is an argument for remaining on it until stabilized on the new med to reduce some of the initial side-effects.

I think just from reading online, it's always saying how you shouldn't "stop as it's dangerous, or it will cause heart issues" etc, so I think I just took that literally, but that might mean for patients who have heart conditions.

The typical dose for high blood pressure range from 120-640mg/day and for post heart attack patients it is around 320mg. At the higher doses it definitely should be tapered off.

I thought the slow release lasted longer in the body?

No, the slow-release formulations just trickle the med into the blood stream over about 24 hours instead of delivering it in one hit. They don't alter the half-life of the med.

So I'm assuming the slow release is well out of my body now? Even if I was taking it everyday for 2 years, when you stop does it come out of your system after 25 hours?

With a few exceptions the length of time a med has been taken doesn't affect the rate it is eliminated. The rule of thumb is most meds are completely metabolized and eliminated by 5 times their half-life. Active metabolites may extend that, however, while propranolol does have an active metabolite, 4-hydroxypropranolol, with chronic dosing the parent drug inhibits it so it has only a relatively small impact, plus it's half-life is also short, between 5-7 hours.

[mischamoonlight]

@panic_down_under I do remember my doctor saying about it being for the adrenaline, so that I do remember. Basically just the physical symptoms of anxiety of panic attacks. I’ll probably stay on the lower dose of the propranolol, and ask my doctor about the other medicine, can’t remember the name of it but they have it on my record, maybe it was for the depression, I’ll have to ask again. For now, I’m still staying on the propranolol.

Didn't actually know blood pressure meds went up that high, so makes sense they’d need tapering. My doctor is probably allowing me to taper because they know of my anxiety disorder and know I’d feel better doing it that way. That’s really good information you’ve given me as well, I’ve done myself more harm by just googling stuff and seeing all the warnings and just letting that stick in my head.

My doctors ringing today to discuss about my medicine anyway, so I’ll be sure to ask everything I need, but yeah, thanks again, this has actually helped a lot.

[panic_down_under]

I've done myself more harm by just googling stuff and seeing all the warnings and just letting that stick in my head.

When it comes to anxiety disorders ignorance is often best.

[mischamoonlight]

@panic_down_under Yeah, I would definitely agree.

Little update: it’s now my 4th day on the lower 40mg dose and so far I’m doing pretty good. I still have my PVCs which I’m learning are normal and not panicking as much, even when I get a bad episode. Haven’t had any bad palpitations either, and I’ve been trying to keep myself busy more, which I think has helped. I take the dose around 9 at night, a couple or so hours before I’m going to sleep and it seems to help. So just wanted to update.